Decoding Physician Assistant Scope of Practice Regulations

All healthcare providers, physicians, nurse practitioners and physician assistants alike practice under a set of rules and regulations. While some of these guidelines are implemented at a federal level, states also get a say in how providers are allowed to practice. These sets of guidelines are referred to as scope of practice regulations. State legislatures have the authority to modify them as they see fit. This means the way each type of provider practices looks different in every state.

While regulations look different in each state, scope of practice laws governing physician assistants typically take six aspects of practice into account, determining how each will be regulated. These include:

1. Licensure as a Regulatory Term

In all states, physician assistants must be licensed in order to practice. While the licensure process can vary somewhat state-by-state, requiring a license allows governments to ensure the quality of healthcare providers. Physician assistants, for example, must pass a national certification exam before a state will award licensure.

2. Prescriptive Authority

Unlike licensure, the authority of physician assistants to prescribe medications varies by state. In Georgia, for example, PAs are not permitted to prescribe Schedule II drugs. Oregon, in contrast, allows physician assistants full prescribing ability and does not limit the type of medications PAs may prescribe. Greater autonomy with prescribing is a critical component of scope of practice regulations. In states where prescribing authority is limited, employers find it more difficult to utilize PAs, and often look to other kinds of providers for staffing.

3. Scope of Practice Determined at Practice Level

Some states may decide that individual practices, rather than the government, are best equip to determine the services physician assistants may provide to their patients. So, instead of outlining these in state law, they ask that each practice determine the services physician assistants may provide in their facility. These guidelines are typically laid out in a formal agreement signed by both the supervising physician and physician assistant. Other states take a more restricted approach, dictating the specific services a PA is allowed to provide as part of scope of practice law.

4. Supervision Requirements

While all physician assistants must practice under some form of physician supervision, the parameters of such supervision differ state-by-state. Scope of practice law may dictate, for example, that new graduates must work in the same facility as a physician for the first several months, or even year, of practice. Other states may dictate that an MD need not be on site with the PA, but that the physician assistant must practice within a specific distance of the supervising physician. Finally, states with fewer regulations for PAs allow supervision requirements to be determined at the practice level. In Utah, Arizona and Texas, for example, healthcare facilities determine what supervision arrangement is most appropriate for their practice setting.

5. Chart Cosignatory Requirements

Cosigning charts for patient encounters is another way scope of practice regulations touch the way physician assistants practice. Essentially, these regulations specify the number of the physician assistant's charts a physician must review. In Kentucky, for example, MDs must review 10 percent of charts for patients seen by the PAs they supervise. Several states like Minnesota and Michigan have adaptable cosignatory requirements, allowing individual practices to set their own chart review requirements.

6. Number of PAs an MD May Supervise

Some level of oversight by a physician is required for a physician assistant to practice. Most states take this a step further, specifying the number of physician assistants a single physician may supervise at any given time. In Washington State, for example, an MD may supervise up to five PAs simultaneously. In Kentucky, however, this number is just two PAs. While the allowable number of physician assistants a single MD can supervise may seem trivial, in reality this can have a big impact. Practices, for example, may not be able to hire more PAs if their physicians are maxed out when it comes to supervision numbers having negative effects on the PA job market.

How do scope of practice regulations in your state affect your work as a physician assistant?

Comments

Just wanted to clear up a few misconceptions. PAs can prescribe in every state just like NP's can. We both got our scheduled drug legislation in Florida which was the 49 for PAs and the 50th for NPs.
Regarding supervision, PAs are not supervised in 50 states. In the VA PAs have collaborative practice. A new law in West Virginia allows them to also. In Michigan PAs have a "participating physician" and prescribe 100% independently. The AAPA House of Delegates just passed something very close to full practice (OTP) which now is policy and will allow PA state organizations to lobby in this regard. You will soon see a number of states I am sure putting up legislation to this effect.
Things are changing fast in the PA world. Just wanted all to know.

David Mittman, ...

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